BOOKING FORM               (To print, hit your browsers print button)

To discuss availability:

Telephone 07974 387 295 - Fax 08712 366 876 - Email Lloyd@Active-Sea-School.co.uk

Mr/Mrs/Miss/Ms ……………..........……………………………………………………Date of Birth ………………………...

Address ………………………..........……………………………………………………………….....................................

…………………………………………..........…………….................. Post Code ………………………………...............

Telephone: Day: …………………...... Eve ………......…………... Email ……………….………...................................

Emergency contact name and telephone number …………………………………………………..................................

Please reserve a place on the following course: ……………………………..........….......Starting on .....…………….....

Details of any medical conditions and/or treatment being received: ........................................................................

I accept the published  Booking Conditions.   I enclose my cheque/cash as full payment for   £………......................

Signature:   ........................................................................................   Date:    ...............................................

We would be very grateful if you would indicate how you first found Active Sea School:

Search Engine ...... Via RYA Website ......  Poster ......  Personal Contact ...... Other:..........................................

Please tick if you require: RYA VHF Radio (inc GMDSS) book £5.50 .......... Portland Plotter/Divider kit  £20 ..........

Return to: Active Sea School (Dover),   71 Folkestone Road,  Dover,  Kent,  CT17 9RZ.